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Home My WebLink About14-199r Authorization Number 1," ._.1 (Office Use Only). u CITY OF IOWA CITY APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday -- Friday.) 410 East Washington Street Iona City. lotra 52240-1826 L,?f_�2.p ;mv,(etg£it'f Li, inhymtoewill d(sult ill denalof, the�„Fga�a (319) 356-5040 (319) 356-5497 FAX �g irst 1. Name (I mEQUll�ED) a �..0 � ®M � RIe"M 2. Mailing Address (REQUIRED) 7,•w s .r., A 6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 411 6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 7. Have you been convicted of any traffic offenses in the last five years? W.' /�,// Where 8. Has your driver's license or chauffeur's license been suspended or revoked in Tvoe of offense Where When When a ••° J 'p.... the last five years? When 9. Have yyo ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an Individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby certify that I shave issued to me by the Iowa Department of T-raospor':adon a valid Chauffeur's license number °� % " �9 � i . i understand that if I falsely ansvvPr any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application, ': consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and docurnents relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (i41es 's tc be signed M, f rC A of a NGimill uubllc) Signature of Applican ✓ Date YOU ARE NOT VALI TO DRIVE A I IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sv✓orn to a.� before me by % a R`@�w_) (� . 5On this day of O` A L'` fA I CA1 4 l R 71131t7l1F1'1T*{fill! - r A■ ,. I have reviewed this application, DCI report, and the State certified driving record of this applicant and nava deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Si o Police Chief or designee IN lite YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 W1(width) and 8 %11 (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update CleddrAXIDRIVBADGEAPPUR014e ended.DOC 09/2014 DO"T A� 1�t, i ll l A WWWr--; A )„ SMARTER 15r4le Ri FF Iti,.� .,a.'c++raummwx , rci, .usv iC'Wff ce 4i �kttN.wrva�wl' recti lu':9e:iu F10 IN',k%t'WIK i Des Ucuuves RA, dlitl*4 fl vharwe 5152.44 srr,6nur..ktwiradof,:"faint Inquiry Date:1 8/13/2014 fi Nallner Pew, Jeremy Nickolas Addresan rr MUSCATINE AVE city/staft: IOWA CITY, IA -i Mailing Addresen 2804 MUSCATINE AVE Mailing City/States IOWA CITY, IA 522402001 5m, TIM17=1 CefttlitlLd Albstrinct of IDlriiviiing IRecDlyd Mlsta ry Information Customer M 1424101 chasm D Audit 0: 5470394 Issue Date: 08/25/2011 Expiration Date.- 1.2/30/2014 Endorsements. None Restrictionst NONE Date of Birft 12/30/1984 Sam M Mlsta ry Information Customer M 1424101 IIl0 Statusu None DL Statum VAL CDH. Status„ None CIrA11. Cent 1Statuum None CDL toed Status„ None Rastdctlon None Supplement: =No Drtver's License Citation Data comd0ion Dae s.CrD .., 2apl- nateon —r—Iv...._ ..—ens ....... ,, ,,.,.,,..,.., ..,..,_. County _....,_. ., 0 it .._.... ........,,. ,_.,._.....,. .. 05!16!700/„ ,. . ....... ..........».w,_,..,_.... ....._.. —/2 0911212007. ......_� _....__. ........,.. _ 057 ... No Drivers I icense __. _....�__.. �. �... .... Muscatine _.�.... uLR_.. 12l14P2007 OI(04(2000 1751 =No Drtver's License Muscatine !IA 01(1:0./2009 ,__,....o :04(06!200[% _,_„ ,._,...,� ._._. B51 _....�,. __.._.._. Wo Drivers Lkense ...,.,e .._ __._ . ..............r.�_.__,.. Muscatine .. IIA ...._......... I.1(3O(d012 .w..w �.... .,,.. i:0.2128l2012 .. ;M74 ... ,__.. tFail to Ohey Traffic 5iignl5ugnal .._....,.».........,_ .».� ,_,_..... 'lohnson IA .. .. 02/0N/7tl13.... '03/06!2011 ........ 5925pead..» ..... v __. < .... Henry _._._.... .. Pienryr.... _ .....JIA...... ..... 05(30(2013 ED6l26l2013 ;Ifnproper Registration 'Johnson IA Accidents ... Acciident !Involvement indicated does NOT 1mean the IndlesidDall was at fault or ggltfeln a cltatllon„ wgixtatent 'Da!k rr 6�iare Yumru•9'xevr 7l'�J',l7uriW l7! tl, V, 6644966 Names Raw, Jeremy Nickolas DL/ID: 775YY4363 WR. Pursuant to Iowa Code §321.10, 1, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this Is a true and accurate copy of an official record currently In the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: ,0 61111201,4 �owP,% Olt w Office of Driver Services Iowa Department of Transportation IMauneu Pew, .Jeremy Nickolas 1011./IID,' 775Y'Y4363 Aug. 18. 2014 12:55PM Div of Criminal Investigation OCIM100763235 NAME: DECOARD'JEREMY J REW,JBRZKr 14ICKOLAS DOB SEX RAC 19841230 M W ADDITIONAL xpxVTxFx9Rs TAT R SNLD AUT WQT SYR HAIR SKN POB 507 230 alto BRO xx No.7640 P. 2/2 AGENCY: IA0520200 IOWA CITY PD CITARGS - 01 1A STATUTE XA714-2(4) EFT 4TH DEOR99 TRK#: 101698901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2(4) THEFT 4TH DEGREE .. 1978 COURT CASS IDa 06521 SRCR074228, CHARGE CLASS: NON CONVICTION TRK#2 101698901 RESTITUTION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20060303 PROBATION 1Y 20060303 20060903 DISCHARGED FROM 20061011 DEFERRED JUDGEMENT AN REST WITHOUT DISPOSITION IS NOT AV INDICATION OF GUILT. THIS RECORD INTAINED BY THE IOWA DIVISION OF CRIMINAL Y STIGATION, BUREAU OF IDENTIFICATION I8 A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE AVSENCE OF FINGERPRINTS FOR POSITIVE XDMIFIChTIOR THIS RECORD IS SED ON INFORMATION FURNISHED. W8 CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION m me/1Aug.18. 2014712: 55PN1;.ab Div of Criminal Investigation �IIII IIIIII u �o m mo r Criminal History Record Chet�. Roquist Form °a'an Town Dhr¢Iejan aorCIrIMIR&k htoraet6aiRan uS8$PPOiPt O6eratton Bureau, 101 irgear 219 L 71s 311neot Dee Mm@meon Iowa 601�p (011)12"a66 ON) 725-6080 Pax t 369 /78 54 WqhWrI bM6OM Whowa has roloalawob per C611e orltawa, c¢ N (FA#)31833827nNo, 7640 P. 1/2002 DCX AanounndtkPxmboau 9 67wi �tLtsyp�Y¢snWRsp FrOMa qY�epl�loww mgBvdnryryapprfro, a �pt� y 'Wa Alyn1� @hone¢ Raxs A�2�3R�7,�a� ' e,v log WAvore o4mdhoaableetofithohiietooyr° ord-knoRwoot 012..'om ImuAft eehsahosI hueteauy readied In %rerut¢attonob AA mtgawvo6 tot NW# mtoerayv aeiMa9 6�eru,o R. re e�oev Aqw 1 r�¢mn roe A666614 asgUN&S aa9aVmtl uA, o dere are ¢® a'�¢�¢a a¢ h¢®uw� me Kaa o �ta� aw Keu�reas kre �rcwt �l 1AVOdSMINIm tOCQ¢ Any WhIfid WIPAVY ds¢e ale m MO. Is iMe¢a Akid%.V AD W MwvjM'MWM4 as wtl¢ vM by My, _....................... Aa of ,., a adardi of the provIdad name and date ofbittls revealed; No Iowa Criminal History Record found vAth DCd VL Iowa CdMinal Hia&a¢y Reawd aftaohsd, DCC dd :I 1 itaitaals Received Time pug. 13. 2014 10:49AM No.7218